Background
In recent years, advances in medical and surgical treatment of constrictive and adhesive pericarditis have substantially enhanced outcomes of patients suffering from these uncommon and complex diseases. Pericardiectomy has emerged as a promising therapeutic option and represents the only definitive treatment in case of chronic constrictive pericarditis poorly responding to other conventional therapies. Comprehensive analyses remain scarce due to the rarity of this conditions. The present study aimed to evaluate demographic and clinical characteristics, perioperative complications, and predictors of in-hospital mortality among all patients who underwent pericardiectomy for constrictive and/or adhesive pericarditis in Germany between 2014 and 2023.
Methods
Anonymized nationwide data from the German Federal Statistical Office (DESTATIS) were analyzed, including all hospitalizations coded for constrictive and/or adhesive pericarditis (ICD-10 I31.1, I31.0) combined with pericardiectomy (OPS 5-372). Demographics, comorbidities, surgical approach, use of cardiopulmonary bypass, postoperative complications, and outcomes were evaluated. Mechanical ventilation duration and in-hospital mortality data were assessed and stratified by age group. Statistical analyses were performed using R (Version 4.4.3), including multivariate logistic regression to identify independent predictors of in-hospital mortality.
Results
A total of 2,319 patients underwent pericardiectomy during the study period, of whom 24.5% were female. Overall, in-hospital mortality was 11.5% (n=267) and increased sharply among sexagenary and elderly patients (>80 years). Concomitant cardiac procedures such as valve surgeries and coronary bypass grafting were performed in 21.0% and 18.3% of cases, respectively. Postsurgical extracorporeal membrane oxygenation (ECMO) was required in a critical subset of patients (27.4%) and was strongly associated with adverse outcomes (OR 6.84, 95% CI 3.20–13.7, p<0.001). The most frequent postoperative complication was bleeding requiring surgical reoperation (32.9%), while acute liver failure occurred in 3.7% of patients but carried a very high fatality rate (OR 4.27, 95% CI 1.70–8.56, p<0.01). In addition, both high-volume blood transfusion (OR 2.79, 95% CI 1.50–5.22, p<0.05), chronic severe kidney disease (OR 2.10, 95% CI 1.05-4.10, p<0.05) and resuscitation (OR 5.73, 95% CI 3.51–9.41, p<0.001) were independently associated with in-hospital death.
Conclusion
Pericardiectomy for constrictive and adhesive pericarditis remains a complex procedure associated considerable perioperative risk, characterized by high in-hospital mortality, particularly in elderly patients, and frequent need of advanced postoperative support. The need for ECMO therapy, prolonged mechanical ventilation, acute hepatic failure, high transfusion volumes, and advanced renal dysfunction were identified as the strongest predictors of in-hospital death. These findings underline the need for refined preoperative risk assessment and early multidisciplinary perioperative management to mitigate complications and improve outcomes.
